Provider Demographics
NPI:1548393101
Name:GOLDSTEIN, JULES II
Entity Type:Individual
Prefix:
First Name:JULES
Middle Name:
Last Name:GOLDSTEIN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5119
Mailing Address - Country:US
Mailing Address - Phone:727-849-4246
Mailing Address - Fax:727-849-0701
Practice Address - Street 1:2605 W SWANN AVE STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4039
Practice Address - Country:US
Practice Address - Phone:813-871-6050
Practice Address - Fax:813-348-0817
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN68091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice